Healthcare Provider Details

I. General information

NPI: 1124543921
Provider Name (Legal Business Name): MEGIE KATHLEEN DICKINSON M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 HIGHWAY 64 E
ALMA AR
72921-6807
US

IV. Provider business mailing address

3656 HEARTHSTONE DR
FAYETTEVILLE AR
72764-6945
US

V. Phone/Fax

Practice location:
  • Phone: 479-632-3813
  • Fax:
Mailing address:
  • Phone: 479-502-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4149
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: